Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Warrensburg, MO | $50.39 | $3.48 – $157.27 | 65,388 | 43 |
| Lake Oswego, OR | $75.03 | $0.00 – $258.36 | 65,340 | 93 |
| Elon, NC | $67.60 | $0.00 – $82.80 | 65,221 | 20 |
| Weaverville, CA | $14.77 | $0.00 – $883.55 | 65,175 | 9 |
| Brunswick, GA | $79.06 | $0.00 – $504.22 | 65,109 | 35 |
| Lexington, MS | $45.88 | $0.00 – $122.06 | 65,098 | 27 |
| Swansea, MA | $39.07 | $3.80 – $69.38 | 65,046 | 33 |
| Denison, IA | $7.78 | $0.00 – $51.84 | 65,045 | 21 |
| North Kansas City, MO | $67.64 | $0.00 – $129.62 | 65,032 | 76 |
| Chewelah, WA | $38.74 | $0.00 – $65.69 | 64,940 | 21 |
| Sandusky, MI | $112.49 | $0.00 – $303.67 | 64,832 | 7 |
| Sheridan, WY | $61.04 | $0.00 – $475.48 | 64,780 | 68 |
| Chinle, AZ | $103.86 | $0.34 – $430.98 | 64,593 | 30 |
| Hallandale Beach, FL | $50.31 | $0.00 – $100.34 | 64,544 | 47 |
| North Arlington, NJ | $55.03 | $31.58 – $130.52 | 64,519 | 18 |
| Holly Springs, MS | $67.01 | $0.00 – $115.02 | 64,468 | 20 |
| Canton, NC | $49.90 | $2.67 – $485.88 | 64,451 | 15 |
| Fort Washington, MD | $87.53 | $0.00 – $125.68 | 64,433 | 29 |
| Booneville, MS | $42.92 | $0.00 – $145.34 | 64,403 | 37 |
| Greenfield, OH | $36.60 | $0.57 – $90.87 | 64,350 | 16 |
| Bonifay, FL | $26.60 | $4.30 – $72.59 | 64,248 | 17 |
| Spearfish, SD | $55.28 | $0.97 – $446.85 | 64,245 | 18 |
| Gray, TN | $37.84 | $20.42 – $95.06 | 64,194 | 22 |
| N Dartmouth, MA | $43.43 | $15.28 – $86.62 | 64,182 | 27 |
| Howard Beach, NY | $71.79 | $8.59 – $125.77 | 64,167 | 32 |
| Pace, FL | $46.47 | $0.00 – $94.03 | 64,162 | 35 |
| Ironwood, MI | $39.84 | $0.56 – $72.43 | 64,129 | 9 |
| Burr Ridge, IL | $64.82 | $0.00 – $245.25 | 64,079 | 55 |
| Waltham, MA | $51.98 | $0.78 – $129.88 | 64,014 | 103 |
| Goose Creek, SC | $73.17 | $7.13 – $134.02 | 63,992 | 33 |
| Yabucoa, PR | $0.54 | $0.00 – $37.14 | 63,984 | 24 |
| North Lima, OH | $48.73 | $0.00 – $81.80 | 63,908 | 24 |
| Glendale, NY | $68.82 | $0.00 – $159.76 | 63,899 | 33 |
| Tomah, WI | $73.15 | $8.19 – $225.27 | 63,863 | 50 |
| Pomeroy, OH | $44.06 | $0.54 – $82.03 | 63,847 | 15 |
| Marina, CA | $41.09 | $0.00 – $682.60 | 63,783 | 23 |
| Gulf Breeze, FL | $57.31 | $0.00 – $145.39 | 63,713 | 41 |
| Rye Brook, NY | $106.03 | $25.73 – $152.51 | 63,693 | 14 |
| Glen Ridge, NJ | $59.64 | $6.84 – $140.31 | 63,655 | 36 |
| Quebradillas, PR | $4.72 | $0.00 – $47.27 | 63,646 | 27 |
| Hillsborough, NC | $67.62 | $21.77 – $100.99 | 63,609 | 51 |
| Spanaway, WA | $54.48 | $0.00 – $67.43 | 63,600 | 23 |
| Bellevue, OH | $39.58 | $23.12 – $118.45 | 63,502 | 26 |
| Kaysville, UT | $49.66 | $1.18 – $78.43 | 63,482 | 19 |
| Wagoner, OK | $70.32 | $13.19 – $109.87 | 63,462 | 28 |
| Mauston, WI | $42.50 | $0.00 – $75.56 | 63,426 | 42 |
| Louisville, CO | $66.59 | $0.00 – $669.33 | 63,406 | 43 |
| East Hampton, NY | $101.72 | $49.70 – $110.34 | 63,386 | 9 |
| Venice, FL | $46.34 | $0.00 – $400.75 | 63,365 | 80 |
| Oxford, MI | $104.63 | $56.77 – $136.75 | 63,323 | 7 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.